Prevalence of impaired glucose tolerance and other types of dysglycaemia among young twins and singletons in Guinea-Bissau

Ditte Egegaard Hennild, Morten Bjerregaard-Andersen, Luis Carlos Joaquím, Kaare Christensen, Morten Sodemann, Henning Beck-Nielsen, Dorte Møller Jensen, Ditte Egegaard Hennild, Morten Bjerregaard-Andersen, Luis Carlos Joaquím, Kaare Christensen, Morten Sodemann, Henning Beck-Nielsen, Dorte Møller Jensen

Abstract

Background: Twins may be at increased risk of dysglycaemic disorders due to adverse fetal conditions. Data from Africa regarding this association is limited. We studied impaired glucose tolerance (IGT) and other types of dysglycemia among twins and singletons in Guinea-Bissau.

Methods: The study was conducted from February 2011 until March 2012 at the Bandim Health Project, a health and demographic surveillance system site in the capital Bissau. Twins (n = 209) and singletons (n = 182) were recruited from a previously established cohort. Oral glucose tolerance tests (OGTT) were performed, along with anthropometrics and collection of clinical and dietary data.

Results: Median age was 16.6 and 14.2 years between twins and singletons, respectively (P = 0.08). Mean birth weight was 2410 vs. 3090 g, respectively (P < 0.001). Twins had higher median fasting- and two hour capillary plasma glucose, 5.4(3.2-8.2) vs. 5.0(3.2-11.5) mmol/L (P < 0.001) and 6.8(3.4-11.3) vs. 6.2(3.2-12.1) mmol/L (P < 0.001), respectively, compared to singletons. The prevalence of IGT was 2.5 % (5/209) vs. 3.5 % (6/182) (RR = 0.73, 95 % CI: 0.20-2.64). 12 % (25/209) of twins had impaired fasting glucose (IFG), compared to 3.5 % (6/182) of singletons (3.63, 1.53-8.62). Dysglycemia (IGT and/or IFG or overt diabetes) was found in 17 % (35/209) vs. 9 % (16/182) (1.90, 1.08-3.37), respectively.

Conclusions: Twins had higher glucose levels in both the fasting and postprandial state. This may indicate a detrimental effect of the twin fetal environment on glucose metabolism later in life, a result contrary to Scandinavian register studies. The IGT burden was low in this young age group and the risk was similar in twins and singletons.

Keywords: Diabetes; Fetal origins hypothesis; Impaired fasting glucose; Impaired glucose tolerance; Low birth weight; Sub-Saharan Africa; Twins.

Figures

Fig. 1
Fig. 1
Inclusion of twins in the OGTT study. *One twin had co-existing IGT and IFG and has in this flowchart been classified as an IGT case
Fig. 2
Fig. 2
Inclusion of singletons in the OGTT study. *Two singletons had co-existing IGT and IFG and have in this flowchart been classified as IGT cases
Fig. 3
Fig. 3
Median glucose levels (mmol/L) in fasting and at one and two hours during OGTT for the subset of twins where zygosity status was known. MZ twins (22/133), DZ twins (111/133), Singletons = 182/182. Interquartile ranges (25 and 75 % percentiles) are displayed. Note: This figure represents a subset of the data, i.e., only those with available zygosity and is therefore not directly comparable to the median values displayed in Table 2

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